New - so many questions

[Matsu1]

I was diagnised w/severe sleep apnia in Oct (AHI 37). I started therapy with Resmed Airsense 11 Dec 29. I had very little problem adjusting to the mask - yay.  Started with APAP 7-11. Nasal mask, lots of mouth leaking.  
   Started mouth taping - leaks pretty much under control.  Adjusted easily to tape - yay again.
   My Obstr Apneas hovered anywhere per night in the 20s for both Obstr Apnea and Central.  There were no Central apneas during my in-lab sleep study.  
   After consulting with a polysom. tech person I went from APAP. to CPAP.   I worked my way up to pressures of 15, 16, 17 without EPR.  Still lots of Central aps. Per his suggestion I have added V-Com with a pressure of 16, EPR 2 (tried EPR 1,2,3).  This has helped.  But I can't get consistent nights of low Central and Obstr events.  
   I'm attaching 2 representative nights - with and without Central aps.  Centrals are more the norm.  I've only had 3 nights with AHI under 2.  Mainly 4-6 range.  I don't know how concerned to be about the central apneas, or the obstructive ones either.  It was suggested I might do better with BiPAP to blow off more C02 (I don't understand the technicalities). My original Polysom tech person has ignored me since his suggestion of V-Com which I what brings me here.  I can tell you my snoring has stopped - another huge yay.  
  Please let me know if you need more information to evaluate my situation.  
Thank you!

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[Matsu1]

I've tried attaching data as jpegs.  I hope this works!
       

[Sleeprider]

Your therapy is at relatively high pressure, and I assume that is because of persistent obstructive events that have required more pressure to resolve. Based on your charts, there is clustering of obstructive events that may respond to positional apnea awareness and mitigation, allowing the use of lower pressure. I think the V-Com is a scam and is counter-intuitive to my understanding of good therapy practice using pressure support or EPR to resolve flow limitations, and I have not found an example of it being beneficial. Consider that a challenge, I'm still waiting for proof of efficacy. Your obstructive events often cluster or occur in multiple events, which is characteristic of a positional apnea where there is poor cervical alignment, chin-tucking, tall or firm or multiple pillows or sleeping on an incline. All of these can be avoided. We have a wiki article for that. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

Take a look and let me know what you think. I'd be interested in seeing a chart without v-com if you're using it. Your flow limits are low, so I think you can concentrate on how to improve any positional issues.

[robbob2112]

So, looking at the v-com it would seem to slow the rate of change in pressure.  But you are currently using straight cpap mode which doesn't change pressure.  And if you were using it in apap mode it would defeat the purpose of the changing pressure.

Is that about your take sleeprider?

P.s. when my pressures hit 16ish my lungs hurt the next day, especially when I take a deep breath.

[Crimson Nape]

Matsu1 - According to V-Comm's documentation, the device adds 2.5cm to your exhalation pressure. This is the exact opposite of the EPR option on a Resmed. It is designed to be used with a static pressure setting and not with any EPR.

Looking at your charts, you have the pressure set to provide a 14cm EPAP. Based on V-Comm's documentation, then you could set your pressure to 11.4 or 11.6 and, using this device, achieve the 14cm EPAP pressure.

- Red

[Matsu1]

I'm back.  I've tried many options, with V-COM, making slow adjustments with different CPAP pressures (between 12 and 16), different EPR, giving each a number of days before switching one factor at a time.  V-COM seemed to help lower OA and CA in the short term.  But over time, my CA's went back up.  

So no more V-COM based on Sleeprider's opininion.  I'd like advice on how to proceed.  One odd thing in comparison with others, I have never had the fatigue symptom. I almost always feel pretty good if I've had at least 7 hours sleep.  I was sent for a sleep study because of snoring.  I don't know how concerned to be with my numbers given I feel pretty good.  
  
The one difference I notice since beginning CPAP therapy (Jan 1, 2024) is I don't wake up during the night.  I used to wake up 3-4 times through the night.   
Here are the last 3 nights. The "settings" are the same all 3 nights:

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[Sleeprider]

Overall, not much has changed. You still have OA events that appear in small clusters. While I normally think of positional issues as causing that, it has been present since your posts in January, and I assume you looked into it. Your event rate remains just over 4/hour which is not all that bad, but it would be nice to see it lower. Your early results at 16/14 with EPR 2 were similar in AHI, but cut the flow limits. I'll trust your judgement in choosing the most effective and comfortable therapy options. Since you don't use EPR it doesn't make sense to pursue bilevel. I really don't have much to suggest in addition to what you have tried.

[Matsu1]

Thanks Sleeprider.  So in general, you think I shouldn't be too concerned about the Central Apneas?  Do you still see them positionally induced?  I've tried a flatter pillow and staying off my back. Though I confess I have not tried a cervical collar.  
  I appreciate your input!